Healthcare Provider Details

I. General information

NPI: 1396790333
Provider Name (Legal Business Name): MICHEAL JOSEPH TELEHANY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

IV. Provider business mailing address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-4400
  • Fax: 585-554-3342
Mailing address:
  • Phone: 585-554-4400
  • Fax: 585-554-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044590-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: